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General NPI Number Information
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NPI Number | 1396678876
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Entity Type | Individual
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Provider Name | SIMONE VENISSA FERGUSON LMSW
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Gender | Female
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Dates
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Enumeration Date | 06/04/2026
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Last Update Date | 06/04/2026
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Provider Practice Location Address
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Address Line | 3430 HIGHWAY 20 SE
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City | CONYERS
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State | GA
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Zip | 30013-2868
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Country | US
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Telephone | 770-922-4482
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Fax | 770-922-4640
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Provider Business Mailing Address
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Address Line | 2003 FIVE OAKS WAY
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City | TUCKER
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State | GA
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Zip | 30084-8152
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Country | US
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Telephone | 203-706-7039
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 104100000X
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Taxonomy Name | Social Worker
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License Number | MSW012322
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License Number State | GA
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